iCNS

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.  Please review it carefully.

 

I am required by applicable federal and state law to maintain the privacy of your health informaion.  I am also required to give you this Notice about my privacy practices, legal obligations and your rights concerning your health information (known as “Protected Health Information” or “PHI).  I must follow the privacy practices that are described in his Notice, which may be amended from time to time.  If you would like more information about these practices or for additional copies of the notice, please feel free to contact me at any time.

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I. Uses and disclosures of protected health information

    A. Permissible Uses and Disclosures without Your Written Authorization

I may use and disclose PHI without your written authorization for specific reasons, which are listed below.  These examples are not meant to be exhaustive but are meant to describe the types of uses and disclosures that federal and state law permit.

1. Treatment purposes: I may use and disclose PHI in order to provide treatment to you, including diagnosis and counseling services.  I may also disclose your PHI to other health care providers who are involved in your treatment in order to consult about your care.

2. Payment purposes: I amy use or disclose your PHI so that the services you receive are appropriately billed to and payment collected from your health plan.  Because we do not accept insurance at the Novian Counseling & Neuroeducation Center, disclosure of this type will only occur if you have requested that your information be used to file out of network.

3. Health Care Operations: I may use and disclose your PHI in connection with health care operations, Employee Assistance Programs, including quality improvement activities, training programs, accreditation, certification, licensing, or credentialing.

4. When Law Requires or Permits: I may use or disclose PHI when I am required or permited to do so by federal and state law.  This includes, but is not limited to appropriate authorities if I reasonably believe that you are a possible victim of neglect, domestic violence, abuse, or other crimes.  I amy also disclose PHI to the extent necessary in order to prevent a serious threat to your health and safety or the health and safety of others.  I amy also disclose PHI for public health activities, health oversight activities including disclosures to state and federal agencies who are authorized to access PHI, judicial and law enforcement officials in response toe a court order or other lawful process.  I may also disclose PHI in relation to research when it is approved by an IRA (institutional review board).  The law permits disclosures to military and national security agencies, coroners, medical examiners and correctional institutions, or when otherwise authorized by law.

     B. Uses and Disclosures which Require Your Written Authorization

1. Psychotherapy Notes: Notes recorded by your clinician which document the contents of a counseling session (known as “Psychotherapy Notes”) may be used only by your clinician.  They may not be disclosed without your written authorization execept when legally requested.

2. Other Uses and Disclosures: Any other Use or disclosure which is not described above will be made only with your written authoriztaion.  I will have you sign a consent to the release of information form before I may send any PHI to any person or entity not entitled by law, and such authorization may be revoked, by written request, at any time.

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II. Individual Rights

1. Right to Inspect and Copy: Your medical records are your own.  You have the right to request access to all your medical and billing records, which I maintain, in order to inspect them and you may request copies of your medical records and billing records which I maintain.  I may deny access to your records in limited circumstances, and may charge a fee for the cost of copying and sending your records to you.  Certain portions of a minor’s medical records are not accessible by parents or legal guardians without court order.

2. Right to Alternative Communication:  I will accomodate any reasonable request that you receive your PHI by an alternative means of communication or at an alternative location, however such requests must be submitted in writing.

3. Right to Request Restriction:  It is within your rights to request restrictions on your PHI which is used for disclosure for treatment, payment or health care operations, but such requests must be submitted in writing to the Privacy Officer identified below.  I am not required to agree to such restrictions, but I will honor any request I deem reasonable.

4. Right to Accounting of Disclosures:  I will provide to you an accounting of certain disclosures of PHI made by me after December 1, 2008 upon written request.  Your right to this information applies to disclosures for purposes other than treatment, payment, or health care operations and excludes disclosures made to you or disclosures you authorized.  It is subject to other restrictions and limitations

5. Right to Request Ammendment: You have the right to request that I amend your health information as long as your request is in writing and explains why the information should be amended.  I may deny this request under certain circumstances.

6. Right to Obtain Notice:  You have the right to obtain a paper copy of this Notice at any time by submitting a request to the Privacy Officer identified below.

 

III. Questions and Complaints

    If you would like more information about your privacy rights or if you are concerned that I have violated these rights, you may contact our Privacy Officer: Kate Novian, whose contact information is below.  You may also file written complaints to the Texas State Board of Examiners of Professional Counselors, the Texas State Board of Examiners of Marriage and Family Therapists (for Dr. Novian only), and/or the Director, Office for Civil Rights of the US Department of Health and Human Services.  I will not retaliate against you if a complaint is filed by you with any of these entities.

 

Privacy Officer: Kate Novian

21015 Market Ridge

San Antonio, TX 78216

(210)831-1282

 

Texas State Board of Examiners of Professional Counselors

Complaints Management and Investigative Section

PO BOX 141369

Austin, TX 78714-1369

Email: lpc@dshs.state.tx.us

Telephone: (515)834-6658

Fax: (512)834-6789

 

Texas State Board of Examiners of Marriage and Family Therapists

Complaints Management and Investigative Section

PO BOX 141369

Austin, TX 78714-1369

Email: mft@dshs.state.tx.us

Telephone: (515)834-6658

Fax: (512)834-6789

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Texas Behavioral Health Executive Council,
Attn: Texas State Board of Examiners of Marriage and Family Therapists,
George H.W. Bush State Office Bldg.1801
Congress Ave., Ste. 7.300
Austin, Texas 78701. Telephone:  1-800-821-3205, or
online:  http://www.bhec.texas.gov/wp-content/uploads/2020/07/BHEC-Complaint-Form.pdf.